With our President and our own intelligence agencies currently in public disagreement about our greatest threats (Southern border migrants {Tweets} VS China, Russia, and North Korea {“Worldwide Threat Assessment”} ), it seems an appropriate time to list again some of the things that might threaten us from a medical point of view. I last did this on February 1, 2010.

Repeats from 2010:

Watching TV– increase chance of a cardiac death by 18%, increase chance of obesity in children by 5%.

Toys – 13,663 head injuries in children from toys seen in an ER in 2005; 251,000 toy injuries seen in ERs in 2018; 41% (102,910) were injuries of face or head.

Sleep apnea in truck drivers – Sleep apnea increases the chance of a driving accident by about 100%; 17% of truck drivers have sleep apnea

Brain cancer from cell phones– no evidence for it in 2010; “maybe” in 2019; very heavy users over 10 years in Sweden had an increased incidence of acoustic neuroma (non-cancerous growth on hearing nerve).

Contaminated herbal supplements – more studies continue to find supplements with incorrectly labeled ingredients and/or unlabeled contaminants. Most of these supplements are for sexual enhancements, body building, or weight loss.

Vaping of nicotine products – “Unknown risks” noted in August 1, 2009; Still unknown over the long term, but of more concern because of the alarming explosion of use by junior high students and 21% of twelfth-graders.( an increase of 1.3 million teens just since 2017) (NEJM 2018 Dec 17)

New threats:

Gun Violence – I am surprised that this wasn’t in my 2010 list since it seems like we have been talking about this threat for years, but it was before the Sandy Hook and Stoneman Douglas school massacres . Wikipedia has a handy list of 122 world-wide school massacres by country, dates, number killed, etc. Do you remember what the auto industry said in the past regarding proposed laws requiring seat belts? – “Cars don’t kill people; people kill people.” I don’t either. Someone must have made that up to make a point. Check my two previous blogs (2015 and 2018) for the comparison of “the frog sitting in the gradually heating up water” with our pace of achieving gun safety. (“By Degrees”, Markerelli.com)

Climate Change – Extreme weather events and raging wildfires in California have caused some to label climate change as a “Health Emergency”. Accompanying an article describing the stress on emergency medical care resources and the significant contribution to air pollution caused by the California wildfires, a lead editorial in the New England Journal of Medicine stated: “Climate change is already adversely affecting human health and health systems, and projected climate change is expected to alter the geographic range and burden of a variety of climate-sensitive health outcomes and to affect the functioning of public health and health care systems.”

Large Gathering in Any Public Place – During a break in the interminable Boston TV coverage of the Patriots prior to Super Bowl LIII one channel showed a segment on the security planned for the Mercedes Benz Stadium in Atlanta. It was impressive; ten miles of fencing, prohibition of drones, helicopter fly-overs, fully-armed policemen, and more-fully-armed soldiers (always shown walking in pairs). Nothing new to us since September 11th. Just another reminder, but now at least we realize it is not actually foreign “terrorists” that have caused the most havoc in our country.

Enough about threats. Any good news?

Salt-free diet not necessary for heart failure patients- A review of 9 studies showed “a paucity of evidence supporting low-sodium diets for patients with heart failure”. The recommended first step is to “… retreat from an unbridled and potentially harmful insistence on rigorous sodium restriction” in these patients. (JAMA Internal Med 2018 Dec; 178)

Vitamin D supplements of no benefit to preventing cancer or cardiovascular disease –A study of 25,800 participants over 50 years old followed for 5 years showed that daily 2000 IU of Vitamin D “did not keep the doctor away” compared to placebo. This is good news for people spending money on vitamin D supplements for this purpose. (NEJM January 3, 2019:380;1)

Stand-up desks at work reduces sitting times – See “Watching TV” above, but unfortunately there are no studies that standing does anything but improve psychological well being of the worker with some work-related benefits. When arising from the sitting position, the authors recommended doing some physical activity. Standing alone is not any healthier. (BMJ 2018 Oct10:363)

“EPIDEMIC” continues to be a common catch word for headlines. Apparently we have lots of epidemics; the flu, HIV, opioid, Zika, gun violence, etc. We spend a lot of tax money investigating and containing epidemics. . . . Oh, . . . all except for that last one: gun violence.

Why is that? In 1996 the Communicable Disease Center (CDC), our federal bulwark against harmful epidemics, was expressly instructed by Congress NOT to study anything related to guns, i.e. don’t give research grants, don’t establish data bases to track events, and don’t sic the EIS on the gun violence epidemic. In one of his rare Executive Orders President Obama instructed the CDC in 2012 to resume their gun violence research and asked Congress to allocate $10 million dollars for that purpose. Congress never did.

EIS stands for the Epidemic Intelligence Service, a division of the CDC. It has a stellar reputation for laser-focussed field analysis of incipient epidemics to guide early actions to contain them, to reduce any harm to people. Just last week the CDC launched an investigation into a cluster of 53 new HIV cases in Lowell, MA. (In 2007 Boston had a “cluster” of 92 gun-related homicides.) Ironically, the CDC remains hamstrung in any effort to collect and analyze data on the gun violence epidemic at a time when it is asking the general public to participate in identifying any other kind of potential epidemic via internet “crowd sourcing” .

The CDC does keep mortality statistics and issues an annual report of causes of death for each state. The difference of gun-related death rates between states is huge, and no one really knows why. Massachusetts had the lowest number of gun-related deaths in 2016: 3.4 deaths per 100,000 population, or 242 gun-related deaths in Massachusetts that year. Texas, Florida, and California had 3,353, 2,704, and 3,184 gun-related deaths respectively that same year. Those three states also had the most suicide deaths and the most accident-related deaths of all the states. That’s interesting, but those rates may not be related in any way to each other . Food for thought? Too bad the CDC can’t collect more data on gun deaths.

A gun is the harmful agent in this epidemic just as a virus is the harmful agent in the AIDS epidemic. True, human behavior is the cause for both of the epidemics spreading, but while we are developing a HIV vaccine we have implemented effective measures to contain the epidemic with “safe sex” campaigns, identification of risk factors, pre-natal treatment of HIV-positive pregnant women, early treatment of exposed newborns, and development of successful medical treatments. All of this was accomplished with the support of the CDC and NIH. Why not provide government support for similar interim steps to reduce the gun violence epidemic? Medical societies and many citizen groups have picked up the “safe gun” banner. Why hasn’t the federal government done so?

One answer is, of course, money. The NRA contributed money to 205 House members (189 Republicans and 16 Democrats) and 42 Senators (35 Republicans and 4 Democrats) in 2012. The Democratic Senator that got the most NRA money got less than the 41 Republicans above him or her on the list. 95 of the top 100 NRA money receivers in the House were Republicans. Most analysts actually consider this as “chump change” ($5,000-10,000 per Congressman) compared to the $18.6 million that the NRA spent on NRA-favorable candidates in the 2012 elections. Analysts speculate that the money buys “allegiance” rather than “influence” (whatever that means). We all know it buys lots of “thoughts and prayers.”

Another answer may be that there are more guns than people in the U.S. It is as if everyone had AIDS, or as if HIV- infected people considered it their constitutional right to do anything with it they wished to. We as a nation did a lot to reduce the harm of HIV without abolishing the HIV virus. Why can’t we take the same approach to gun violence? We could do quite a bit without abolishing guns if we could do research about how guns are spread, how they are used for harm (In fact, 50% of gun deaths are suicides), how we could reduce harmful use (electronic signatures, smart guns, trigger locks, no multiple cartridge magazine, etc.).

The significant reduction of auto accidents deaths was accomplished by multiple means (seat belts, car seat regulations, air bags, electronic sensors, changes in car manufacture, speed limit regulations, etc,) and not by abolishing cars or drivers’ licenses. With better data perhaps we could take effective action to reduce the gun death epidemic.

All I know is just what I read in the papers.Will Rogers

You can never get all the facts from just one newspaper,
and unless you have all the facts, you cannot make properjudgements about what is going on.Harry S. Truman

I usually start thinking about what to write in my next blog a few days before the 1st and 15th of the month. This Tuesday, January 26 I picked up a newspaper and was immediately struck by the number of medically relevant articles (some of which contained “medical fun facts”, from front page headlines to blurbs in the business section. Here are some of them.

El Salvador Advises Women to Stop having Babies for 2 Years Because of the Zika Virus (front page)Zika is a mosquito-bornevirus that causes minor symptom in an adult but can cause severe microcephaly and even death in a fetus. First reported n Brazil, 5000 adult cases have been identified in El Salvador. The rate of infected fetuses is not known. Turns out that the above recommendation has not caused much of a stir in El Salvador. In comparison to other developing countries its birth rate is low. Salvadorian women list their reasons as: 1. fear of violence, 2. poor economics and widespread poverty, and 3. their acceptance of contraception (despite the church’s stand), and now 4. Zika virus. Some have gone so far as to deride the recommendation as a government conspiracy to reduce the birth rate in “this most densely populated country on the entire continent” (per their Health Minister). Zika has caused more of a stir here, and our CDC has advised pregnant U.S. citizens not to travel to Central and South America.

As someone who is not usually receptive to conspiracy theories, I myself feel a bit concerned about “just who” is controlling information. This story sort of “dribbled out” as a minor note only to explode rapidly on the front page with lots of “known facts.”

Grand Jury Indicts the Accusers of Planned Parenthood (lead story on front page)The Texas grand jury convened to investigate the criminal activity of Planned Parenthood as alleged by the Center for Medical Progress has instead indicted the Center’s founder Mr.Daleiden and Ms. Merritt, makers of the “selling baby parts” videos. After two months of investigating the evidence the grand jury issued indictments for a federal offense (illegal changes made to fake California driver licenses) and a misdemeanor (offering $1600 per sample to Planned Parenthood for fetal tissue which is against existing law).

That this grand jury was impaneled by a Republic DA in a Republican state with a Republican governor made this unexpected result immediately newsworthy because of the rabid Republican-led Congressional attacks on Planned Parenthood. Planned Parenthood noted that this was the eleventh investigation of them that found no wrongdoing.

Gluten-Free Diet Did Not Benefit Competitive Athletes (first page of Well Section)A two week double-blind study of 13 seriously training, competitive cyclists eating indistinguishable gluten-free and gluten-laced sports bars revealed no difference in general feeling, performance, or inflammatory markers related to sports bar type. The researcher remarked that, “Unless you are having gastrointestinal problems a gluten-free diet will probably provide no benefit… I hope that people learn to be more objective in terms of what they hear and read about gluten-free diets and nutrition in general.” (1)

EKG Screening For College Basketball Players? (Op Ed page)When the chief medical officer of the NCAA recommended in March 2015 that all male college basketball players should get a electrocardiogram (EKG) because of the risk of sudden cardiac death, 100 college team physicians reacted very loudly. They strongly pointed out that the inaccuracy of EKG screening causes lots of expensive and unnecessary medical investigation of commonly occurring “false positive” results. Another problem is that rates of sudden death in these students has been calculated to be all the way as low as 1 in 50,000-100,00 to as high as 1 in 1,300 (higher than the risk of dying in an auto accident). The American Heart Association and the American College of Cardiology both oppose EKG screening of 460,000 U.S. college athletes. Some colleges do require it. The newspaper editor suggests “maybe just for high-risk basketball and soccer players”. “More data later” remains the medical mantra.

More Gun Violence, (multiple pages, no surprise,)Dorchester, Boston: A 34 year old male was shot in the abdomen at 2:35 PM because he had taken another male’s parking spot. The shooter sped away in a black BMW. East Boston: At 2 PM on the inbound Blue Line of the MBTA a man getting off the train turned around and fired 5 shots at a man he had been arguing with. He hit the 29 year old target and a 43 year old man just standing on the platform. Windham, Maine: A 33 year old man arising from bed in his house in the early morning hours opened fire with a shotgun at a figure at the end of the stairs that he thought was an intruder. It was his wife who had gotten up earlier. , Mass: An intoxicated 60 year old man was arrested for firing a gun at a snowplow driver in Plymouth Saturday night.
…………(NY Times probably doesn’t even report such common happenings)

Autism Therapies to be Tested on Genetically Engineered Monkeys (bottom of page in Science section)Mice are not useful research models for studying social cognition and interaction, so scientists in China have turned to genetically engineered monkeys to test drug therapies for autism . The monkeys born from eggs injected with the human MECP2 gene (associated with autism) showed more repetitive behavior, more stress responses, more defensive behavior, more grunting when people gazed at them, and less social interaction than other monkeys. The higher cost of developing such monkeys compared to mice, the difficulty of equating monkey behavior to human autistic behavior, and the fact that the implanted gene is found only in the monkey’s nerves and not throughout their brains means that this “break-through” may not be all that helpful(2). Though it could be a good science fiction plot. Synopsis: “Lab break-in releases autistic monkeys. Presidential primary candidates attack (or defend) animal rights activists, but most push their campaign ad content up to a higher reading level.”